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PubMed1999

Venous leg ulcers: modern evaluation and management.

BACKGROUND: Venous leg ulcers are common in the adult population and cause a significant social economic burden. Despite their prevalence, venous leg ulcers are often managed inadequately. OBJECTIVE: To provide an overview of venous ulceration, including a review of the current understanding of the pathophysiology of venous ulceration and the implications for management of venous ulceration. METHODS: A review of the literature. RESULTS: Modern methods of investigation have led to an improvement in our understanding of the pathophysiology of venous disease. In many patients, superficial and/or perforator venous disease is the only underlying hemodynamic abnormality. Although compression should serve as the cornerstone of treatment of venous ulceration, surgery and/or sclerotherapy can treat incompetent superficial and perforator veins. Important hemodynamic improvement is obtained, and the long-term prognosis of these patients is greatly improved. CONCLUSION: One must define the basic underlying abnormality of the venous system to form a rational, individualized management plan for the patient with venous ulceration.

Adult↗
PubMedDate not supplied

Gender issues and Japanese family-centered caregiving for frail elderly parents or parents-in-law in modern Japan: from the sociocultural and historical perspectives.

This paper presents a sociocultural and historical literature review of gender related issues associated with family-centered caregiving for frail, elderly relatives in modern Japan. Issues addressed from a Japanese perspective are (a) women and social norms of caregiving, (b) feminine identity and caregiving, (c) women in the workforce, and (d) women and caregiving. Implications for research are also discussed.

Attitude to Health↗
PubMed2003

TB vaccines at the turn of the century: insights into immunity to M. tuberculosis and modern approaches for prevention of an ancient disease.

Tuberculosis (TB) remains a leading cause of infectious disease mortality worldwide, accounting for nearly 2 million deaths annually. Despite the availability of effective anti-TB therapy, the world's case burden of TB continues to climb, in part owing to the concurrent acquired immune deficiency syndrome pandemic. The widespread use of the current TB vaccine, the bacille Calmette-Guérin strain of M. bovis (BCG), has failed to curtail the TB epidemic and therefore strategies for the eradication of TB have centered on aggressive case-finding and managed treatment, such as directly observed treatment short course (DOTS). Although DOTS continues to have a significant impact, the ability of DOTS to eradicate TB is limited. Therefore, TB eradication will require the development of an improved vaccine, which, in turn, will require application of state-of-the-art vaccine technology and of our knowledge of TB immunology and TB genomics to this problem. In this article, knowledge about the requisite components of protective immunity, modern vaccine strategies, and elements of clinical trials required to evaluate vaccine efficacy, as well as the status of current TB vaccine candidates, are reviewed.

BCG Vaccine↗
PubMed1999

Similitude in modern pharmacology.

The principle of the similitude, the basis of homeopathy, has correspondences in the clinical studies of secondary effects of many modern pharmaceutical agents through the observation of the rebound effects of these drugs. Through clinical pharmacology, I proposed a model on which to base the scientificism of the homeopathic model. We have studied the effects of the drugs in the human body using pharmacological compendia and recent scientific works, confirming the mechanism of the homeopathic medicines' action through the verification of the primary action of the drugs and the consequent secondary reaction of the organism in hundreds of pharmaceutical agents. Treatment exploiting the "rebound" effect (curative vital reaction) may also be observed. This work suggests a research methodology to scientifically base the therapeutic principle of similitude.

Feedback↗
PubMed1999

Biotypology II: modern concepts.

Modern concepts of biotypology are based on embryological concepts. Based on the work of Nebel and Vannier, described in part I of this article, Bernard related endoblast mesoblast and ectoblast to Carbonic, Sulphuric and Phosphoric constitutions respectively. These in turn are linked to particular morphologies and disease susceptibilities, and the question of an inherited tuberculous predisposition has been much debated. The reaction of particular biotypes to stress has been analysed in terms of Selye's Adaptation Syndrome. Bernard has also analysed the pathological progression of biotypes in terms of a sequence of salts: Calcium, Magnesium, Potassium, Sodium, Barium and Ammonium.

Body Constitution↗
PubMed2002

Modern forensic medicine and the medico-legal system in Iran.

The history of forensic medicine as it is practised today in Iran is described. Modern forensic medicine was not introduced into Iran until the 1850s. At present, there are two organizations in Iran involved in the forensic medicine field: 1) the Universities of Medical Sciences, 2) the Legal Medicine Organization (L.M.O.), and its Medico-Legal Centres (M.L.Cs) in the provinces and cities. These organizations are closely related to each other. The L.M.O. is an official body of the Judiciary, which is situated in Tehran. The L.M.O. and the M.L.Cs are responsible for providing expert witness reports on technical and scientific subjects related to forensic sciences when required by the courts, Judges and the administration. Forensic medicine specialization is achieved after a 3-year full training residency. In Iran, medico-legal autopsies are performed for the investigation of suspicious deaths and crimes. Death investigation in Iran is described.

Journal Article↗
PubMed2000

Modernity and the emerging futurism in neurosurgery.

This article discusses the emergence of neurosurgery in its 'modern' form during the second half of the 20th century and presents the apertures to the 21st century that are apparent in establishing an evolving futurism in the field. Factors of primary positive impetus and challenges are discussed.

Forecasting↗
PubMed1999

Modern diets and diseases: NO-zinc balance. Under Th1, zinc and nitrogen monoxide (NO) collectively protect against viruses, AIDS, autoimmunity, diabetes, allergies, asthma, infectious diseases, atherosclerosis and cancer.

Thanks to progress in zinc research, it is now possible to describe in more detail how zinc ions (Zn++) and nitrogen monoxide (NO), together with glutathione (GSH) and its oxidized form, GSSG, help to regulate immune responses to antigens. NO appears to be able to liberate Zn++ from metallothionein (MT), an intracellular storage molecule for metal ions such as zinc (Zn++) and copper (Cu++). Both Zn++ and Cu++ show a concentration-dependent inactivation of a protease essential for the proliferation of the AIDS virus HIV-1, while zinc can help prevent diabetes complications through its intracellular activation of the enzyme sorbitol dehydrogenase (SDH). A Zn++ deficiency can lead to a premature transition from efficient Th1-dependent cellular antiviral immune functions to Th2-dependent humoral immune functions. Deficiencies of Zn++, NO and/or GSH shift the Th1/Th2 balance towards Th2, as do deficiencies of any of the essential nutrients (ENs) - a group that includes methionine, cysteine, arginine, vitamins A, B, C and E, zinc and selenium (Se) - because these are necessary for the synthesis and maintenance of sufficient amounts of GSH, MT and NO. Via the Th1/Th2 balance, Zn++, NO, MT and GSH collectively determine the progress and outcome of many diseases. Disregulation of the Th1/Th2 balance is responsible for autoimmune disorders such as diabetes mellitus. Under Th2, levels of interleukin-4 (II-4), II-6, II-10, leukotriene B4 (LTB4) and prostaglandin E2 (PGE2) are raised, while levels of II-2, Zn++, NO and other substances are lowered. This makes things easier for viruses like HIV-1 which multiply in Th2 cells but rarely, if ever, in Th1 cells. AIDS viruses (HIVs) enter immune cells with the aid of the CD4 cell surface receptor in combination with a number of co-receptors which include CCR3, CCR5 and CXCR4. Remarkably, the cell surface receptor for LTB4 (BLTR) also seems to act as a co-receptor for CD4, which helps HIVs to infect immune cells. The Th2 cytokine II-4 increases the number of CXCR4 and BLTR co-receptors, as a result of which, under Th2, the HIV strains that infect immune cells are precisely those that are best able to accelerate the AIDS disease process. The II-4 released under Th2 therefore not only promotes the production of more HIVs and the rate at which they infect immune cells, it also stimulates selection for the more virulent strains. Zn++ inhibit LTB4 production and numbers of LTB4 receptors (BLTRs) in a concentration-dependent way. Zn++ help cells to keep their LTB4 'doors' shut against the more virulent strains of HIV. Moreover, a sufficiency of Zn++ and NO prevents a shift of the Th1/Th2 balance towards Th2 and thereby slows the proliferation of HIV, which it also does by inactivating the HIV protease. Research makes it look likely that deficiencies of ENs such as zinc promote the proliferation of Th2 cells at the expense of Th1 cells. Zinc deficiency also promotes cancer. Under the influence of Th1 cells, zinc inhibits the growth of tumours by activating the endogenous tumour-suppressor endostatin, which inhibits angiogenesis. The modern Western diet, with its excess of refined products such as sugar, alcohol and fats, often contains, per calorie, a deficiency of ENs such as zinc, selenium and vitamins A, B, C and E, which results in disturbed immune functions, a shifted Th1/Th2 balance, chronic (viral) infections, obesity, atherosclerosis, autoimmunity, allergies and cancer. In view of this, an optimization of dietary composition would seem to give the best chance of beating (viral) epidemics and common (chronic) diseases at a realistic price.

Animals↗
PubMed1976

[The effect of increased performance of modern x-ray tubes on improvements in picture quality, particularly of moving organs (author's transl)].

The deleterious effect of organ movement on radiographic quality is examined. In connection with this, the performance of various focal spots is discussed, particularly of a modern high speed tube with focal spots of 1.2, 1.5 and 1.8, with a resolution in the region of 3 to 6 lp/mm. A detailed discussion of the results is given with examples derived from various techniques used for the stomach and lungs. The results indicate that there is considerable improvement to be derived from high performance tubes with small focal spots. A further significant advance is also due to the high resolution image intensifiers. These have resulted in a marked increase in the use of 70 and 100 mm. film.

Humans↗
PubMed2000

Reanimation of the paralyzed eyelid with the enhanced palpebral spring or the gold weight: modern replacements for tarsorrhaphy.

The enhanced palpebral spring and the gold weight are the modern devices that should nearly completely replace tarsorrhaphy in the management of ocular problems secondary to facial paralysis. They actually reanimate the lid, rather than merely hold the lids closed in a disfigured position, as does tarsorrhaphy. The surgical techniques of each procedure, results, and pros and cons of each are compared. Personal experience with over 1400 spring implantations is discussed, as is experience with the use of bandage contact lenses in lieu of lid surgery. The gold weight implantation is simpler to learn and perform than the enhanced spring procedure, in which the levator is tightened in addition to implanting the spring. However, when it is really important to close the eye well, the spring is the superior procedure. Unlike the weight, the spring closes the eye well in the supine position, such as when the patient sleeps.

Contact Lenses↗
PubMed2000

[Injury profile in modern competitive karate--analysis of 1999 WKC-Karate World Championship Games in Bochum].

Competitions in Karate are either carried out as Shobu sanbon (with fist padding) or Shobu Ippon (without fist padding). Aim of this study was to gain current data on injuries in modern competitive Karate and to compare the two different competitive systems. During the WKC-Karate-World-Championships held from June 12-13 1999 at Bochum, 392 bouts were carried out. Every injury that was seen by the tournament doctor was registered. 142 competitors sustained 168 injuries: 141 mostly minor contusions of the head and throat, 12 facial lacerations, 3 knock-outs (mild brain injury), 3 thoracal contusions, 1 midfoot fracture and 9 other blunt injuries. We saw more injuries in Shobu Sanbon (146/302 bouts) than in Shobu Ippon (23/90). Most of the injuries (152) were caused by punches. In Shobu Sanbon, kicking techniques led to 17 injuries only. The injury pattern shown here is comparable to earlier studies. Severe injuries in competitive Karate are rare. The higher number of injuries in Shobu sanbon may be due to the longer fighting time and higher scoring. Fist pads used in Shobu Sanbon might also lead to a loss of control. Therefore, prophylactic fist padding to avoid injuries in competitive Karate has to be seen critically.

Adolescent↗
PubMedDate not supplied

[Joint biomechanics and design of modern knee prostheses--time for revised thinking!].

AIM AND METHOD: This review article summarises new knowledge about knee kinematics and induces a new discussion about the design of total knee arthroplasty (TKA) components. RESULTS: According to these new observations, knee flexion is not linked to femoral rollback but to a rotational movement between tibia and femur. The axis of this rotation is situated in the medial compartment of the knee when an intact anterior craciate ligament is present and not centrally through the tibial spines. In case of ACL insufficiency, such as that following TKA, the center of rotation shifts into the lateral compartment. Furthermore, the form of the posterior femoral condyle is not elliptical but round. CONCLUSION: Rotational movements between femoral component and tibial baseplate with the polyethylene-inlay have to be possible. One needs an asymmetric surface of the polyethylene-inlay, because different movements occur in the medial compartment than in the lateral compartment. The option to construct the posterior femoral condyle with a single radius allows a high congruency with the articulating inlay. The surgeon should let the new findings influence his choice of a TKA system. A closer analysis of modern prosthetic designs with either fixed or mobile bearings reveals that a few systems have already incorporated some of the new kinematic aspects of the knee.

Anterior Cruciate Ligament↗
PubMed2001

[Long-term results of radium contact irradiation of laryngeal carcinoma and their relevance in modern therapeutical regimens].

BACKGROUND: Despite the fact that it is widely accepted that a second radiogenic carcinoma might occur after radiotherapy of laryngeal carcinomas, there are only a few long-term follow-up studies published yet. METHODS: Between 1973 and 1988 193 patients have been treated by radium contact irradiation because of glottic cancer (Tcis, T1, T2). After the cancer had been diagnosed by biopsy, a partial resection of the thyroid cartilage in the shape of a window 16 x 18 mm was carried out and a self-retaining capsule which harbours the radium was brought into position. RESULTS: 190 (181 men and 9 women) out of 193 patients could be followed up. At the time of investigation 109 patients had already died, 66 intercurrently. The actuarial disease free survival rate 5 and 10 years for Tcis/T1 glottic cancers were 84.6% and 83.6%. For T2 carcinomas a rate of 100% was found respectively. The actuarial overall survival rate was 96.8% after 5 and 93.1% after 10 years for Tcis/T1 carcinomas. The T2 carcinomas revealed an actuarial overall survival rate of 100% after 5 and 10 years. CONCLUSIONS: As the results of radium contact irradiation are not better than those which can be achieved by microsurgery or modern irradiation techniques no indication exists for a radium contact irradiation of glottic laryngeal cancer today.

Adult↗
PubMed2002

[Wilhelm Griesingers "Magna Charta" of psychiatry. Its reception and impact on modern psychiatry].

The work of Wilhelm Griesinger, really a magna charta of psychiatry, is usually reduced to just one sentence: "Geisteskrankheiten sind Gehirnkrankheiten", roughly: "mental illnesses are brain disorders". However, this is neither explicitly stated in Griesingers work nor does it adequately summarise his conception. This misinterpretation will be questioned by a careful analysis of the literature, and, in addition to that, the dimensions of Griesingers psychiatry including its delayed impact on the development of modern psychiatry will be described.

Germany↗
PubMed2002

[On the history of the concept neurasthenia and its modern variants chronic-fatigue-syndrome, fibromyalgia and multiple chemical sensitivities].

This article deals with the history of the terminological and nosological development of the concept neurasthenia introduced in 1869 by George Miller Beard and in particular with its reappearance in western medicine in the 1980 s. Beginning with its predecessors in antiquity and continuing with hypochondria, which became a fashionable disease in the 18 th century, the concept neurasthenia reached a high point and world-wide medical acceptance at the end of the 19 th/beginning of the 20 th century. However, between the 1930 s and 1960 s it declined in popularity and gradually disappeared until finally it only had a rudimentary nosological role in the term "pseudoneurasthenia". In the countries of the Far East, on the contrary, the concept of neurasthenia has been in continual use since its importation in the first decades of the last century. In the 1980 s, when an interest in the symptoms of chronic fatigue was reawakened in western medicine, the concept neurasthenia reappeared, this time to define the particular form of a neurotic disorder. Parallel to these developments increasing importance was attached to clinical descriptions of illnesses which on account of their similarity to the symptoms of neurasthenia could be termed modern variants of the concept neurasthenia. These are "Chronic-Fatigue-Syndrome", "Fibromyalgia" and "Multiple Chemical Sensitivities" which have more or less adopted the organic inheritance of Beard's former concept of neurasthenia, despite the fact that so far the question of organicity could not be decisively answered in a single case. In order to clarify possible influences on the development of the concept neurasthenia and its variants, the theories and ideas of E. Shorter, medical historian at the University of Toronto, are discussed in the final part of the article, whereby the particular cultural background in each case has a decisive influence on the manifestation of the psychosomatic symptoms.

Depression↗
PubMedDate not supplied

[Modern carbon fibre orthoses in the management of polio patients--a critical evaluation of the functional aspects].

AIM: Evaluation of practicability and functional benefit with modern carbon fibre knee ankle foot orthoses in polio patients. METHODS: In a retrospective analysis, fifty-five (55) polio patients between the ages of 42 and 80 years who had been provided with a carbon fibre orthoses for a minimum of three months, were asked about their acceptance as well as changes in functional capacity and comfort. RESULTS: Clear improvements were shown in walking, sitting and automobile driving as well as comfort and dressing/undressing of the orthoses. Through the use of these new orthoses, the maximum walking distance increased significantly--at least partially due to less weight (40%). 95% of all treated patients were very satisfied or satisfied. CONCLUSION: The use of carbon fibre material in the orthotic treatment of polio patients seems to be supported by the positive results of our study.

Activities of Daily Living↗
PubMed2005

[Expensive modern therapy options in intensive care medicine in Germany-- are they being used? Results of a questionnaire].

BACKGROUND: The use of new, high-priced therapies in intensive care medicine should be assessed by a questionnaire. METHODS: Questionnaires were sent to 849 intensive care units in Germany. The use of three new strategies were asked: treatment of methicilline resistant staphylococcus aureus (MRSA) patients (using linezolid), of severe bleeding (using rFVIIa), and of severe sepsis (using activated protein C [aPC]). RESULTS: Approximately 39 % of the questionnaires were answered and analyzed. All three new strategies were only rarely or very rarely used in Germany even in universities and hospitals with more than 1000 beds. This appears to be very astonishing because all substances were subject to extensive marketing campaigns, received scientific prices (linezolid) or were strongly recommended by some scientific societies (aPC). One major concern to the use of the new approaches was based on the high pricing. Prices were assessed as excessive or very excessive. In spite of a mass of information about the substances, a lot of the intensivists reviewed the scientific basis as weak and not justifying the use of the costly substances. CONCLUSIONS: Modern, costly pharmaceutical approaches in intensive care medicine are widely not accepted in Germany. Especially a tight financial corset hinders most intensivists to use these strategies that may be life-saving in some patients. A solution to this problem is urgently required that can be reached only in intensive exchange with all who are responsible for this dilemma.

Acetamides↗
PubMed2005

[Implementation of modern operating room management -- experiences made at an university hospital].

Caused by structural changes in health care the general need for cost control is evident for all hospitals. As operating room is one of the most cost-intensive sectors in a hospital, optimisation of workflow processes in this area is of particular interest for health care providers. While modern operating room management is established in several clinics yet, others are less prepared for economic challenges. Therefore, the operating room statute of the Charité university hospital useful for other hospitals to develop an own concept is presented. In addition, experiences made with implementation of new management structures are described and results obtained over the last 5 years are reported. Whereas the total number of operation procedures increased by 15 %, the operating room utilization increased more markedly in terms of time and cases. Summarizing the results, central operating room management has been proved to be an effective tool to increase the efficiency of workflow processes in the operating room.

Cost Control↗